Effects of psychological interventions on fear of cancer recurrence: A systematic review and network meta-analysis

Abstract

The study aimed to systematically compare the effects of psychological interventions on relieving fear of cancer recurrence (FCR) by a systematic review and network meta-analysis (NMA). The relevant randomized controlled trials were searched from China National Knowledge Infrastructure, Wanfang Database, VIP Database for Chinese Technical Periodicals, Chinese Biomedical Literature Database, Cochrane Library, Pubmed, Web of Science, CINAHL, PsycINFO, and Embase. The retrieval time was from the establishment of each database to January 23, 2024. Review Manager 5.4 software was used to evaluate the quality of each literature that met the inclusion and exclusion criteria. Stata16.0 was used for NMA. Standardized mean differences (SMDs) of patients' FCR outcomes and 95% confidence intervals (CIs) were used to determine the effects. Inconsistency test, network map, surface under the cumulative rankings curve (SUCRA), comparison-adjusted funnel plot were performed. A total of 41 articles were included, with 4056 patients and 15 psychological interventions. Six psychological interventions (NT, Narrative Therapy; ACT, Accept and Commitment Therapy; GT, Therapy based on Gratitude-Expanded Behavior Theory; Blend Cognitive Behavior Therapy; PERMA, PERMA Therapy; CBT, Cognitive Behavior Therapy) were effective in alleviating FCR in the short term compared with usual care, whereas the effects of ACT, GT, and CBT were sustained up to more than 3 months postintervention. NT ranked as most likely to alleviate FCR, (SUCRA: 89.8%, SMD: −2.89, 95% CI: −4.08 to −1.69), followed by ACT (SUCRA: 88.1%, SMD: −2.83, 95% CI: −4.38 to −1.27) in short-term effects. GT ranked as most likely to alleviate FCR in long-term effects (SUCRA: 100%, SMD: −3.35, 95% CI: −4.21 to −2.50), followed by ACT (SUCRA: 88.9%, SMD: −1.64, 95% CI: −2.36 to −0.91). However, most of the quality of evidence for pairwise comparison was rated as “very low” to “low.” The evidence can help inform evidence-based practice and guide healthcare providers in deciding on the most effective psychological interventions for FCR, which should also be viewed with caution due to the low level of the quality.

Keywords

cancer / fear of cancer recurrence / network meta-analysis / psychological interventions

References

[1] Wild CP, Weiderpass E, Stewart BW. World Cancer Report: Cancer Research for Cancer Prevention. International Agency for Research on Cancer; 2020.

[2] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.

[3] Siegel RL, Miller KD, Fuchs H, Jemal A. Cancer statistics. CA Cancer J Clin. 2022;72:7-33.

[4] Yang Y, Wen Y, Bedi C, Humphris G. The relationship between cancer patient's fear of recurrence and chemotherapy: a systematic review and meta-analysis. J Psychosom Res. 2017;98:55-63.

[5] Simard S, Thewes B, Humphris G, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013;7(3):300-322.

[6] Luigjes-Huizer YL, Tauber NM, Humphris G, et al. What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis. Psychooncology. 2022;31(6):879-892.

[7] Butow P, Sharpe L, Thewes B, Turner J, Gilchrist J, Beith J. Fear of cancer recurrence: a practical guide for clinicians. Oncology (Williston Park). 2018;32(1):32-38.

[8] Lyu MM, Siah RC, Lam ASL, Cheng KKF. The effect of psychological interventions on fear of cancer recurrence in breast cancer survivors: a systematic review and meta-analysis. J Adv Nurs. 2022;78(10):3069-3082.

[9] Hall DL, Luberto CM, Philpotts LL, Song R, Park ER, Yeh GY. Mind-body interventions for fear of cancer recurrence: a systematic review and meta-analysis. Psychooncology. 2018;27(11):2546-2558.

[10] Tauber NM, O'Toole MS, Dinkel A, et al. Effect of psychological intervention on fear of cancer recurrence: a systematic review and meta-analysis. J Clin Oncol. 2019;37(31):2899-2915.

[11] Cillessen L, Johannsen M, Speckens AEM, Zachariae R. Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: a systematic review and meta-analysis of randomized controlled trials. Psychooncology. 2019;28(12):2257-2269.

[12] Li H, Wu J, Ni Q, Zhang J, Wang Y, He G. Systematic review and meta-analysis of effectiveness of acceptance and commitment therapy in patients with breast cancer. Nurs Res. 2021;70(4):E152-E160.

[13] Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162(11):777-784.

[14] Higgins JPT, Thomas J, Chandler J, et al., eds. Cochrane Handbook for Systematic Reviews of Interventions Version 6.3. Cochrane; 2022 Available from www.training.cochrane.org/handbook

[15] Rouse B, Chaimani A, Li T. Network meta-analysis: an introduction for clinicians. Intern Emerg Med. 2017;12(1):103-111.

[16] Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64(2):163-171.

[17] Nikolakopoulou A, Higgins JPT, Papakonstantinou T, et al. CINeMA: an approach for assessing confidence in the results of a network meta-analysis. PLoS Med. 2020;17:1-19.

[18] Zhang Z, Zeng XJ, Huang XX, Qihua H. Application of cognitive behavioral intervention program in fear of disease progression in patients with non-Hodgkin's lymphoma. J Qilu Nurs. 2021;27(1):11-14.

[19] Cheng CY. An Empirical Study of Cognitive-Behavioral Intervention on Fear of Disease Progression in Patients with Non-Hodgkin's Lymphoma. Dissertation. Zhengzhou University. 2019.

[20] Li XZ, Cao MC, Deng JY, Zeng M, Ou L. The effect of narrative therapy on the level of fear and hope of cancer recurrence in patients with nasopharyngeal carcinoma. J Nurs. 2020;27(11):71-74.

[21] Qiu H. A Study of the Effect of Gratitude-Expansive Behavior Theory on Fear of Recurrence in Breast Cancer Chemotherapy Patients. Dissertation. Huzhou Normal University. 2020.

[22] Zhang JM, Fu J, Li YM, Dong J. Effects of narrative therapy on fear of cancer recurrence and hope level in patients with lung cancer undergoing chemotherapy. Chin J Clin Oncol Rehabil. 2021;28(6):733-736.

[23] Wang JJ. The Effect of a Positive Psychological Intervention in the PERMA Model on Fear of Cancer Recurrence in Breast Cancer Patients. Dissertation. Nanhua University. 2021.

[24] Wang LN. A Study of the Intervention Effect of Acceptance Commitment Therapy on Recurrence Fear and Psychological Flexibility in Lung Cancer Patients. Dissertation. Jilin University. 2021.

[25] Wang XM. A Study on the Effect of Positive Thought Stress Reduction Therapy on the Intervention of Fear of Cancer Recurrence in Breast Cancer Patients. Dissertation. Shixenze University. 2021.

[26] Zhang YQ, Wang YX, Zhao J. Effect of cognitive-behavioral intervention on the level of fear of disease progression and negative emotions in patients with glioma. Chin J Modern Nursing. 2018;24(1):39-44.

[27] Zhao MN, Li QF, Wu QG, et al. Effects of a cognitive-existential group intervention on fear of cancer recurrence in lung cancer chemotherapy patients. Guangdong Med. 2018;39(5):782-785.

[28] Wang JM, Mei HY, Sun YL. Effects of mindfulness and relaxation training on the fear of cancer recurrence, cancer-related fatigue and sleep quality in breast cancer patients. Chin J Clin Oncol Rehabil. 2021;28(2):228-233.

[29] Burm R, Thewes B, Rodwell L, et al. Long-term efficacy and cost-effectiveness of blended cognitive behavior therapy for high fear of recurrence in breast, prostate and colorectal cancer survivors: follow-up of the SWORD randomized controlled trial. BMC Cancer. 2019;19(1):462.

[30] Frangou E, Bertelli G, Love S, et al. OVPSYCH2: a randomized controlled trial of psychological support versus standard of care following chemotherapy for ovarian cancer. Gynecol Oncol. 2021;162(2):431-439.

[31] Dodds SE, Pace TW, Bell ML, et al. Feasibility of cognitively-based compassion training (CBCT) for breast cancer survivors: a randomized, wait list controlled pilot study. Support Care Cancer. 2015;23(12):3599-3608.

[32] Gonzalez-Hernandez E, Romero R, Campos D, et al. Cognitively-based compassion training (CBCT®) in breast cancer survivors: a randomized clinical trial study. Integr Cancer Ther. 2018;17(3):684-696.

[33] Herschbach P, Berg P, Waadt S, et al. Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychother Psychosom. 2010;79(1):31-38.

[34] van de Wal M, Thewes B, Gielissen M, Speckens A, Prins J. Efficacy of blended cognitive behavior therapy for high fear of recurrence in breast, prostate, and colorectal cancer survivors: the SWORD study, a randomized controlled trial. J Clin Oncol. 2017;35(19):2173-2183.

[35] Russell L, Ugalde A, Orellana L, et al. A pilot randomised controlled trial of an online mindfulness-based program for people diagnosed with melanoma. Support Care Cancer. 2019;27(7):2735-2746.

[36] Murphy MJ, Newby JM, Butow P, et al. Randomised controlled trial of internet-delivered cognitive behaviour therapy for clinical depression and/or anxiety in cancer survivors (iCanADAPT early). Psychooncology. 2020;29(1):76-85.

[37] Robins CJ, Keng SL, Ekblad AG, Brantley JG. Effects of mindfulness-based stress reduction on emotional experience and expression: a randomized controlled trial. J Clin Psychol. 2012;68(1):117-131.

[38] Lengacher CA, Gruss LF, Kip KE, et al. Mindfulness-based stress reduction for breast cancer survivors (MBSR(BC)): evaluating mediators of psychological and physical outcomes in a large randomized controlled trial. J Behav Med. 2021;44(5):591-604.

[39] Lengacher CA, Shelton MM, Reich RR, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-195.

[40] Luigjes-Huizer YL, Helsper CW, de Wit NJ, van der Lee ML. Effectiveness of a guided online primary care intervention for fear of cancer recurrence: a randomised controlled trial. Psychooncology. 2023;32(12):1839-1847.

[41] Tauber NM, O'Toole MS, Jensen AB, et al. ConquerFear-group: a randomized controlled trial of an online-delivered group-based psychological intervention for fear of cancer recurrence in breast cancer survivors. Psychooncology. 2023;32(9):1424-1432.

[42] Butow PN, Turner J, Gilchrist J, et al. Randomized trial of conquer fear: a novel, theoretically based psychosocial intervention for fear of cancer recurrence. J Clin Oncol. 2017;35(36):4066-4077.

[43] Lee JT, Lee YH, Chang YP. Mindfulness stress management for female cancer survivors facing the uncertainty of disease progression: a randomized controlled study. Int J Environ Res Public Health. 2022;19(8):4497.

[44] Peng L, Yang Y, Chen M, et al. Effects of an online mindfulness-based intervention on fear of cancer recurrence and quality of life among Chinese breast cancer survivors. Complement Ther Clin Pract. 2022;49:101686.

[45] Li Z. Effects of a cognitive behavioral intervention on disease fear and sleep quality in patients with oral oncology. Chin Nurs Res. 2021;35(3):534-537.

[46] Deng J, Ming J, Wang YD, Lu S, Qin D. A study of the effect of cognitive-behavioral stress management on fear of recurrence in young postoperative breast cancer patients. J Nurs Train. 2022;37(5):459-462+479.

[47] Zhu BJ. A Survey on the Current Status of Fear of Cancer Recurrence in Postoperative Cervical Cancer Patients and the Effect of Cognitive-Behavioral Intervention Research. Dissertation. Tianjin University of Chinese Medicine. 2020.

[48] Qi Y. A Study of the Effectiveness of Acceptance Commitment Therapy Intervention on Fear of Cancer Recurrence in Lymphoma Patients. Dissertation. Zhengzhou University. 2022.

[49] Gong RF, Liu JE, Wang QL. Effect of acceptance commitment therapy on fear of cancer recurrence in patients with recurrent oral cancer. J Nurs Sci. 2019;34(16):84-86+102.

[50] Chen Y. A Study of the Effect of Nursing Intervention on the Fear of Cancer Recurrence in Bladder Cancer Patients Based on the Gratitude Topology-Construction Theory. Dissertation. Nanchang University. 2023.

[51] Shi ZH, Liu Y, Long YW. Effects of a cognitive behavioral intervention on psychological resilience and fear of cancer recurrence in glioma patients. J Qilu Nurs. 2022;28(3):5-8.

[52] Cheng YZ, Kang TT, Shang K. Study on the effect of positive stress reduction intervention on fear of disease progression and level of positive thoughts in ovarian cancer patients in chemotherapy stage. Wisdom Health. 2023;9(7):220-225.

[53] Liu HX, Liu WJ, Zhang HP. A study of the value of the PERMA model of well-being care in reducing the fear of cancer recurrence in geriatric non-small cell lung cancer. Mod Med Health. 2022;38(5):856-859.

[54] Chen LT. Effect of narrative nursing on the fear of cancer recurrence and psychological status in patients with Hodgkin lymphoma. Chin Foreign Med Re. 2022;20(7):120-123.

[55] Yang C, Zhu YX. The effect of narrative care on fear of cancer recurrence in radiotherapy patients with head and neck tumors. Chin Contemp Med. 2022;29(5):160-163+168.

[56] Custers JAE, Kwakkenbos L, Levis B, et al. Randomized controlled trial of an individual blended cognitive behavioral therapy to reduce psychological distress among distressed colorectal cancer survivors: the COloRectal canceR distrEss reduCTion trial. Psychooncology. 2024;33(1):e6270.

[57] Zeng F, Hu J, Rong L. Effects of narrative therapy on fear of cancer recurrence, psychological resilience, and level of positive thinking in lung cancer chemotherapy patients. Int J Nursing. 2022;41(8):1423-1427.

[58] Yin D, Zou XF, Li RY, Qiu ZH. Effect of nursing intervention based on the PERMA model on fear of recurrence in patients with esophageal cancer. Shanghai Nurs. 2023;23(10):13-16.

[59] Liao WC, Chien KL, Lin YL, et al. Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol. 2013;14(11):1095-1103.

[60] Zhang SY, Li Q, Zhu JF, Fang L, Zhang LE. Meta-analysis of the effects of a positive psychological intervention based on the PERMA model on subjective well-being and negative emotions in cancer patients. Chin J Health Psychol. 2023;31(5):661-666.

[61] Wang Y, Li X, Dong LY, Jiao H, Xu M. Meta-analysis of the effectiveness of networked cognitive behavioral therapy-based interventions for negative emotions and quality of life in cancer patients. Chin Nurs Res. 2023;37(1):62-68.

[62] White M. Maps of Narrative Practice. W.W.Nort on&Co; 2007.

[63] Yang SX. Narrative therapy: blooming narrative self under discourse. J Minnan Normal Univ (Philosophy and Social Science Edition). 2013;27(4):134-141.

[64] Kyeong S, Kim J, Kim DJ, Kim HE, Kim JJ. Effects of gratitude meditation on neural network functional connectivity and brain-heart coupling. Sci Rep. 2017;7(1):5058.

[65] Fredrickson BL, Joiner T. Positive emotions trigger upward spirals toward emotional well-being. Psychol Sci. 2002;13(2):172-175.

[66] Fredrickson BL. What good are positive emotions? Rev Gen Psychol. 1998;2(3):300-319.

[67] Kwakkenbos L. 3.10. Evaluation of interventions: feasibility, efficacy and effectiveness trials. In: Asmundson GJG, ed. Comprehensive Clinical Psychology; 2022:137-147.

RIGHTS & PERMISSIONS

2024 2024 The Author(s). Precision Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital.